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confirmed by Reverdin, Kocher, Bircher, and others, that after being in situ for a greater or less length of time, the grafts in many instances are very liable to undergo atrophy, to become indurated and converted into mere fibrous bands, and then to cease functioning, when the disease reappears. These changes in the grafts have been attributed viagra pill appearance to their altered environ- ment, depression of vitality, diminished vascular sup- ply, and to ill-understood changes of nervous innerva- tion. In a certain proportion of cases the grafts do not grow at all. If thyroid grafting is now practically abandoned, this is not because the grafting was unsuc- cessful, but rather because subsequent experiments showed that the viagra pill appearance extract was just as efficient against myxcedema when given by the stomach a far more convenient way of administration. Just here it ought to be pointed out that although the similarities of myxcedema and pancreatic diabetes are, as we have shown, remarkably close and striking, in one particular a fundamental difference between them is noted. The thyroid ferment, whatever be its viagra pill appearance intimate nature, is clearly not destroyed by the stom- duced by disturbances or lesions of the sympathetic system (vaso- motor nerves). (2) Both are viagra substitute cheap due, in the majority of cases, to atrophy of a gland, the thyroid in myxcedema, the pancreas in true diabetes (Hausmann). (3) Suppression of a peculiar enzyme or ferment made in the thyroid gland gives rise to the morbid complex of symptoms called myxcedema ; suppression of the glycolytic ferment made in the pancreas gives rise to true diabetes. (4) Total extirpation of the goitrous thyroid gland causes myxcedema in a respectable proportion of cases (Kocher) ; total extirpation of the pancreas causes diabetes in a large proportion of cases (seventy-five viagra pill appearance per cent., De Renzi and Reale; one hundred percent., Minkowsky). (5) If a small fragment of the pancreas be left in the abdominal cavity, after operation on that gland, diabetes is averted ; if a small viagra substitute cheap fragment of the thyroid gland be left after surgical opera- tion on that gland, myxcedema is (usually) averted. viagra substitute cheap (6) In both diseases success has attended thyroid and viagra substitute cheap pancre- atic grafting {vide Thiroloix, Minkowsky, Valli, and Hedon's re- cent experiments). (7) In both maladies treatment addresses itself to supplying artificially a ferment which these glands, owing to disease or de- struction, are no longer capable of elaborating. Success has at- tended the treatment in myxcedema, and is now claimed for diabetes. 1 British Medical Journal, January 14, 1S93. Burney Yeo, " Manual of Treatment," vol. i., p. 450. 724 MEDICAL RECORD. [May 23, 1896 ach chemistry or by the portal circulation, since cures of myxcedema are wrought when it is exhibited by the mouth. On the other hand, the pancreatic extract used against diabetes, given by the stomach, has been uni- formly unsuccessful; and this is no doubt attributable to the fact that, being a nitrogenous body, it is itself destroyed by the pepsin and trypsin ferments of the stomach. A consideration of these facts in physio- jical chemistry will probably explain past failures to cure pancreatic diabetes when the pancreatic ex- tract or raw pancreas was exhibited by the mouth. viagra substitute cheap Normally, according to Professor Le'pine, the glyco- lytic ferment elaborated by the pancreas is not poured into the duodenum along with its other secretions, but is taken up by the lymphatics and carried thence di- rectly through the thoracic duct to the blood. It thus escapes alimentary digestion on the one hand and the viagra pill appearance iportal circulation on the other. It would be well to Oceep this fact steadily in viagra substitute cheap view when using artificial pancreatic emulsions for diabetes in man. It will be seen that obstacles one by one are being gradually surmounted, difficulties are being overcome, .and light is being thrown on the dark places; viagra substitute cheap yet, de- spite all this, doubts are still suggested and difficul- ties presented at every turn. But medical science, like the Sibyl, only reveals her secrets to time leaf by leaf. Points needing further elucidation are : Whether or not diabetes in man will respond to pancreatic in- jections and to pancreatic grafting in the same way as does diabetes in animals; effects on the human organ- ism of subcutaneous injections of the extract (on the Jieart, the respiration, the nervous system, etc.) ; the manner of preparing a sterilized pancreatic extract for ilinical use; the proper viagra pill appearance dosage and frequency of in- jections: viagra substitute cheap its freedom from danger or the reverse: the ^technique of its administration, and perhaps other natters. These, however, are matters of detail and the difficulties can no doubt be smoothed over by the exercise of a little patience and further experimenta- tion in our hospitals and laboratories. The essential point, the fundamental proposition that sugar in the 3)lood of diabetic animals is destroyed by artificial glycolytic ferments, appears to have been established 3by Valli, Battistini, Torup, Minkowsky, Thiroloix, and others. All else in comparison is of but second- n v importance.' To sum up, I have endeavored to show : (1) That a causal relationship is proven to exist, in 1 large viagra pill appearance proportion of cases, between '"lean" or true diabetes mellitus and degenerative or destructive le- i "l the pancreas. (2 i That sugar is destroyed in the blood of diabetic animals (a) by the subcutaneous injections of a pan-